A Doctor Writes – The Digital Future of the NHS

Published: 8th September 2016

Dr David Griffiths

In the third of his blogs, our Clinical Lead, David Griffiths, reflects on the newly published Wachter Report on using IT to improve healthcare.

The Wachter Report on using IT to improve healthcare was published on Wednesday. Having read it, I don’t disagree with any of the major themes or recommendations. We need to digitise, we need to mix centralisation with localism, we need to do this all at pace, yet not so fast that failure becomes inevitable.

What struck me most though was overall finding number 9: A Successful Digital Strategy Must be Multifaceted and Requires Workforce Development. Our experience at Consultant Connect shows just this.

Personally, I think it’s undeniable that the service meets a need. I don’t know of any GP who wouldn’t welcome better channels of communication with their consultant colleagues. It is harder for me to guess what consultants think but I imagine they would prefer to offer upstream advice to ensure patients get the right care in the right place, first time. Consultant Connect is a technology that addresses these two problems.

However, you probably won’t be surprised to hear that take up varies. Like any innovation, people need time to get their heads around it, to see how it can fit within their existing working patterns, how it can be flexed to their needs. We see the typical early adopters, we see the regular users adopting further down the line and we see the laggards. We have also seen that the first experience matters: if the advice was succinct, credible, useful then the user will more likely ring again the next time.

The reason for pointing out all these seemingly obvious factors, is to highlight one of the big challenges for commissioners of Consultant Connect. Yes, it is important that the service is used but it is equally important that it is used well. The type of advice which GPs, in my view, need is a mixture of clinical information – what tests are required, what treatment would be best, all specific to the psychosocial context – and local service advice – the best way for the patient to receive the care they need in the local healthcare system.

In my personal experience, and having researched the use of Consultant Connect, my impression is that almost all consultants are very good at providing clinical advice but a much smaller proportion are effective system navigators. This is not a criticism of the consultant body: there are at least two very good reasons for this. Firstly, this sort of thinking is not something which we typically teach and secondly this type of system knowledge is usually only acquired by experience and, arguably, only by those whose working lives touch on a wide variety of services.

It is just a hypothesis, but I wonder whether a super-specialist consultant, while being highly competent to give clinical advice, may not know the full range of service options available to manage complex patients in the community. These types of question are not easy; they are the ones which GPs agonise over, how best to care for frail elderly patients who may not want or suit the hospital paradigm.

The data generated through the Consultant Connect service can obviously give valuable insights into referral and admission patterns. But it can tell us other things too, such as where the workforce can be helped to offer improved system navigation as well as excellent clinical advice. All of which brings us back to Wachter – a successful digital strategy does require workforce development, and a really successful digital strategy can help identify where that development is required.